Peritoneal Dialysis

Dialysis is a procedure that does some of the work healthy kidneys do. Peritoneal dialysis is a kind of dialysis that uses the thin lining of the belly (peritoneum) and a fluid called dialysate to remove wastes, salt, and extra water from the blood.

Before beginning peritoneal dialysis you will have surgery to place a thin, plastic tube (catheter) in your belly. The tube will be small, soft, and easy to hide. It will be used to fill your belly with fluid and drain your belly of fluid.

HOW DOES IT WORK?

At the start of the session your belly will be filled with fluid. Wastes, salt, and extra water in your blood will pass through the thin lining of your belly into the fluid. At the end of the session the fluid will be drained into a bag. Then the belly will be refilled with fluid and the procedure will be repeated.

The process of draining fluid from the belly and filling the belly with fluid is called an exchange. The time the fluid stays in your body before you drain it is called a dwell. The dwell varies from person to person. It usually takes from 1.5–3 hours.

Peritoneal dialysis is done during the day or at night while you are sleeping. When it is done during the day it is called continuous ambulatory peritoneal dialysis (CAPD). In CAPD, exchanges are done up to 5 times a day. Each exchange takes about 30–40 minutes. You may go about your day normally between exchanges.

Peritoneal dialysis that is done at night is called continuous cycling peritoneal dialysis (CCPD). In CCPD, a machine called a cycler performs exchanges while you are sleeping. Sometimes a combination of CAPD and CCPD is needed.

PREPARING FOR AN EXCHANGE

Check your blood pressure if told by your doctor.

Warm the fluid bag using a dry heating pad. Leave the fluid in the bag with the cover on while doing this. Do not use a microwave or hot water to warm the fluid bag.

If you are using a machine, make sure it is set up and programmed correctly.

Keep your tubing free of germs (sterile).

Make sure the tube in your belly and its cap are free of germs.

If you are using a machine, make sure the part that attaches the bag and tubing to the the tube in your belly is free of germs.

Make sure the area around the tube in your belly is free of germs.

Prevent new germs from getting on your tubing.

Wash your hands thoroughly. Use a gel or foam.

Close doors and windows. Turn off any fans. Make sure you are in a space without drafts or air currents. Doing these things reduces the chance of infection.

Wear a mask to cover your nose and mouth. Do this before you wash your hands and touch equipment. Keep the mask on during each exchange.

Examine the fluid bag:

Make sure the bag is the right size. Size information is on the label. Make sure it has the correct liquid.

Gently squeeze the bag to make sure there are no leaks.

Look at the color of the fluid. The fluid should be clear. You should be able to see any writing on the side of the bag clearly through the liquid. Do not use it if it is cloudy.

Check the expiration date. The expiration date is on the label. If it is past the expiration date, throw the bag away.

HOW TO DO AN EXCHANGE

These steps show how exchanges are commonly done. The actual way in which an exchange should be done varies from person to person. Always do exchanges exactly the way that your doctor has trained you to. Remember to always wash your hands before touching any tubing. This is very important. It helps prevent infection.

CAPD

Hang your fluid bag above your belly on the IV pole.

Place a drain bag below your belly.

Pull out the ring of y-shaped tubing that connects both bags.

Uncap the tube that is connected to the tube in your belly (transfer set). Immediately attach it to the y-shaped tubing of the fluid and drain bags.

Twist open the clamp on the transfer set. This will cause the fluid in your belly to drain through the tube that goes to the drain bag (drain line). It usually takes about 20 minutes for all of the fluid to drain.

Once the fluid has finished draining, twist lock the clamp of the transfer set. Then clamp the drain line.

Break the seal (frangible) on the tubing that is connected to the fluid bag (fill line). Then unclamp the drain line. Air bubbles will flow into the drain line. Make sure your transfer set is still locked so that no air gets into the belly.

Count to 5. Then clamp the drain line.

Twist the transfer set clamp to open it. Fluid will flow into your belly. This should take about 10 minutes.

When this is done, twist the transfer set clamp to lock it. Then clamp the tubing of the fill line.

Detach the tubing from the tube in your belly. Cap the transfer set right away. Tape the transfer set to your belly as told.

Look at the fluid that has drained. It may look like urine, but it should be clear.

Weigh the drain bag. Write down how much was drained.

Check your blood pressure, temperature, and pulse if it is the first exchange of the day.

Allow the fluid to stay in the belly for as long as told by your doctor. You may go about your day while the fluid is in your belly.

If your body cannot go all night without an exchange, a machine may be used to perform exchanges while you sleep. The machine is similar to the one used during CCPD.

CCPD

When you are ready for bed, put the fluid bags onto the machine. Put on exactly the number of bags that your doctor said to use.

The machine has a small cartridge (cassette) with tubing that attaches to each fluid bag and the tube that goes to the patient (patient line). Depending on the number of fluid bags you are to use, all the tubes on the cassette may need to be connected to separate fluid bags. If you use fewer bags than there are tubes on the cassette, the extra lines will need to be clamped.

Insert the cassette with the attached tubing into the front of the machine.

Make sure that the drain line extends to the toilet. The tip of the drain line should not touch the water in the toilet bowl.

Pull the ring on the tubing from the fluid bag on the heating pad of the machine and attach it to the first tube of the cassette. Then break the seal on the tubing of this fluid bag.

Repeat this process with all the bags you need to use.

Start the machine. This will prepare (prime) the machine and tubing by filling it with fluid and getting rid of all the air in the tubes.

Once all lines are prepared, the machine will tell you to connect yourself.

Remove the pull ring from the patient line with one hand.

Uncap your transfer set and attach it to the patient line.

Twist open the clamp on the transfer set.

Press "GO" on the machine. It will begin the draining and filling process. The machine may do 3–5 exchanges overnight, depending on what your doctor recommended.

In the morning, record all volumes and times shown on the machine.

Press "GO" on the machine. The machine will then tell you to close all clamps.

Close your transfer set twist clamp and then clamp all the tubes that go to the machine.

When told by the machine, disconnect the patient line from the transfer set. Re-cap your transfer set right away.

Tape the transfer set to your belly as told.

Check your blood pressure, temperature, and pulse.

The fluid that is in your belly in the morning will stay there during the day.

If the body cannot go all day without an exchange, you may need to perform an exchange during the day. Follow the steps under CAPD if an extra exchange is needed.

HOME CARE

Follow diet instructions as told by your doctor.

Always keep the fluid bags and other supplies in a cool, clean, and dry place.

Keep a strict schedule. Dialysis must be done every day. Do not skip a day or an exchange. Make sure to make time for each exchange.

Weigh yourself every day. Sudden weight gain may be a sign of a problem.